First Coast leaders describe their priorities for fixing U.S. health care

Sunday

Jul 26, 2009 at 12:01 AM

Jeremy Cox

As the Tolstoyesque bills wending through Congress illustrate, reforming America's health care system is complicated business. What if reform could be accomplished in a more Hemingwayesque way? Say, in 200 words or less. That was the challenge, in essence, the Times-Union posed to several health care experts and other community leaders. Their responses were solicited to the following question: "Of all the things that could be re-engineered in America's health care system, what do you think is the biggest priority and how would you fix it?" Here is what they wrote back.

CORRINE BROWN

U.S. representative, DEMOCRAT, JACKSONVILLE

I am in full support of comprehensive health care reform; the need is clear. Many of my constituents, and minorities nationwide from the African American and Hispanic communities, make up nearly half of the estimated 50 million Americans without health insurance.

In Florida, nearly 21 percent of our residents are uninsured. Moreover, health care costs are unsustainable: Medicare and Medicaid may be near bankruptcy by 2017, and one-fifth of our nation's gross domestic product will go toward health care spending.

However, when many good ideas are introduced in Congress, what eventually translates to actual policy gets altered. And one aspect of health care reform of utmost importance to me is maintaining proper funding for Disproportionate Share Hospitals, like Shands Jacksonville and Miami's Jackson Memorial Hospital, which provide health care to uninsured and/or individuals with limited incomes.

Disproportionate Share Hospitals are invaluable, as they are the one true safety net for the working poor nationwide. For a state like Florida in particular, with a large elderly population, crippling [these hospitals] would be disastrous.

I will work with the Obama administration and my colleagues on Capitol Hill to make health care reform a better, more suitable plan for everyone, especially vulnerable populations.

ANDER CRENSHAW

U.S. representative, REPUBLICAN, Jacksonville

America has the best quality of health care in the world, but when millions of Americans can't access it, we have a crisis.

First and foremost, any reform should lower health care costs so more people can acquire coverage and get better care, and ensure patients can choose their own doctor and get the treatment they need when they need it.

The Democrat-proposed government-run health care reform bill would do none of these. At a cost of $1.2 trillion, Americans will have to pay more for less choice. Instead, I and other House Republicans have offered a proposal that would increase availability and access and lower costs by:

- Letting Americans who like their health care coverage keep it and give them the freedom to choose the health plan that best fits their needs;

- Allowing states, small businesses, associations and organizations to band together and offer lower-cost health insurance;

First and foremost, our system of health coverage must focus on the health of patients.

That might seem to go without saying. However, the need for appropriate and timely access to health care is not what drives most of the decisions in our current system. In fact, that need is often an afterthought.

So if there's one key to reform, it's clearly setting the right goal, namely guaranteeing Americans access to affordable, quality health care. That requires assurance that you can get meaningful and affordable coverage if you don't have it. That also requires assurance that if you have good coverage today, you will have good coverage throughout your life.

A reformed system can achieve both of those aims, but only if we insist that patients come first. If we don't, we'll likely fail to achieve either one.

When patients come first, the interests of all of the other stakeholders in the health care system, though important, must become secondary.

Insurers must not neglect health outcomes in favor of profits. Doctors must provide treatment that is patient- centered but also cost-effective. Health care financing mechanisms must emphasize keys like prevention and coordinated care. And taxpayers must understand the cost of doing nothing.

HUGH GREENE

president and CEO, Baptist Health

Achieving affordable coverage for all is a most desired end of any health care reform. This requires "comprehensive" change, which by definition necessitates the complex interaction of multiple factors.

While there is no single "fix" to achieve this goal, I would take the longer-term view and prioritize an increased investment in primary care services. This change effects several positive results: achieving better coordination of care, insuring a greater emphasis on preventive services and health promotion, accomplishing more effective management of chronic diseases, and reducing health care costs. (The Commonwealth Fund estimates that strengthening care coordination through primary care reduces $60 billion over five years for Medicare alone.)

What is needed to assure this enhanced role of primary care?

First, it will require increasing the number of primary care residency slots and offering incentives for medical school students to choose primary care as their profession. Furthermore, this cannot be accomplished without also compensating primary care physicians at a higher level. Medicare should lead the way by enhanced payment for primary care, which is actually being contemplated in the current reform efforts.

CHRYSTAL HUTCHISON

Deputy director, Florida Consumer Action Network

As we build on what works in our current health care system and fix what doesn't, we need to address the long history of discrimination in medical treatment and reorient the way doctors, hospitals, insurance companies and government programs provide care.

This nation's more than 103 million people of color suffer disproportionately in our health care system. For example, in Florida about 27 percent of African-Americans are uninsured, a rate 55 percent greater than for white people. People of color have a shorter life expectancy and have a higher infant mortality rate - a key indicator of a healthy community.

Legislation in Congress right now offers an opportunity to erase persistent health disparities in the U.S.

The public option reform bill would identify key health and health care disparities in addressing prevention and wellness, require insurers to contract with essential community providers, provide adequate funding for preventive services in underserved communities, and designate an assistant secretary for health information whose job it would be to measure, study and reduce health and health care disparities.

We must provide quality, affordable health care to everyone, regardless of race, ethnicity, sex or income. A public option health insurance plan will begin to bridge the gaps of health equity.

RANDY KAMMER and DAVID PIZZI

Vice president, regulatory affairs and public policy; director of health care policy, Blue Cross and Blue Shield of Florida, based in Jacksonville

Our country spends $2.4 trillion dollars on health care, more than any country. Reform initiatives must include significant cost reduction features to make a meaningful difference.

We must move from an illness to a wellness model, providing incentives to health providers to treat the whole patient and urging everyone to take more personal responsibility for their health. Malpractice reform is critical to protect medical providers against unwarranted liability claims, thereby eliminating the cost of defensive medicine.

Respected research estimates that 30 percent of all medical care is unnecessary or duplicative. The only way to address unnecessary care is to create processes that provide incentives for medical care delivery in a rational and consistent manner through the adoption of research based standards.

Mandating enforceable coverage for individuals is an important first step in assuring access and reducing the number of uninsured. Insurers will not deny coverage to anyone with this mandate. However, coverage will not be affordable without cost reduction. Health insurance costs are driven by increases in medical costs. If medical costs are not contained, insurance will never be affordable.

BRIAN KLEPPER

Principal of Healthcare Performance Inc., of Atlantic Beach

We can improve America's health care system by correcting four deep flaws in its structure. First, we should get rid of lobbying contributions that influence lawmakers to favor special interests over common interest.

Next, re-empower primary care. In America, 30 percent of doctors provide primary care and 70 percent are specialists. In other developed nations, the ratio is reversed. Their costs are half of ours and their quality is often superior.

Third, publish cost and quality data - like Consumer Reports does - on doctors, hospitals, health plans, drugs, devices and treatments so health care can finally work like a market. Performance information will help purchasers understand value and will favor those who consistently deliver high quality at low cost.

Last, stop paying for procedures. Instead, pay for results. Many doctors are paid for every service they provide, so they deliver lots of unnecessary services. To get better quality care at lower cost, we need to change the way we reimburse for care.

The health industry has vigorously opposed these measures. But many experts agree they would make health care higher quality and more affordable.

R. STEPHEN LUCIE

Orthopedic surgeon, president, Duval County Medical Society

Americans have access to the best health care in the world. Unfortunately, when it comes to health care, we have a cost-is-no-object attitude.

In order to institute meaningful health care reform, we must first institute federal medical liability reform. Defensive medicine is costing this country from $100 billion to $178 billion per year. National insurance reform is needed to regulate an industry that has made it nearly impossible for an individual to purchase affordable health insurance.

Americans also have to take responsibility for their own actions. Obesity alone costs more than $100 billion a year in related medical treatment. And finally, we must come to terms with end-of-life care and the enormous expenses and resources utilized during the last six months of a person's life. Until we come to terms with medical costs, a government health care plan will only put us further in debt.

AUDREY MORAN

CEO, Sulzbacher Center

Access to mental health care must be a top priority. A 2006 study found that 100,000 people in Duval County suffered from some form of mental illness, 62,000 with serious disorders. Only 12 percent received the care they needed, and the number of people seeking mental health services only has increased.

It is estimated that 30 percent of the homeless population - approximately 840 people from our community alone - suffer from serious mental illness. Few psychiatrists can be accessed without insurance, so the homeless and uninsured have nowhere to go for the care they so desperately need.

Nonprofit safety net clinics, like the federally qualified health centers operated by the Sulzbacher Center, can fix this. Our downtown clinic served more than 400 people with mental illness last year and we expect a significant increase in 2009. Our clinic at the beach began seeing patients in January, and it is already at capacity.

Funding more clinics like the ones at Sulzbacher will mean that the homeless and uninsured will be able to have access to the critical care they need. And that improves the quality of life for all of us.

Never miss a story

Choose the plan that's right for you.
Digital access or digital and print delivery.

Stay Connected

Original content available for non-commercial use under a Creative Commons license, except where noted.
The Florida Times-Union ~ 1 Riverside Ave., Jacksonville, FL 32202 ~ Privacy Policy ~ Terms Of Service